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Residential Load Letter

General InformationService Location (Street Address)

Customer Contact Address

Electrical Contractor Address Phone

Type of Service (Check all that apply)UndergroundOverhead

Service Change (Rewire)Relocation

NewTemporary

Service CharacteristicsSize of Load Wires:

Terminations (Check one):

Sets of Load Wires Per Phase: Load Wire Type (Check one):

Meterbase Connection Box C.T. Cabinet Other

AL CU

Service Size (Check one)

Electrical Load (excluding motors)

Form No. 742705 (July 2021) © 2021 Dominion Energy

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Page 1 of 2

Phone ( )

Use of Premise (Check one):Full time residence (occupied 180 days or greater/year)Seasonal residence

tons

tons

The information provided in this document is critical to Dominion Energy in sizing our electrical facilities to provide reliable service. This information will also be used to determine the installation cost for electrical service. See page 2 for instructions.

The Company reserves the right to designate and /or approve the location of all metering and C.T. equipment. The Company must approve all proposed metering arrangements. The customer must notify Dominion Energy prior to the actual connection of any future load (as required by Information and Requirements for Electric Service, The Blue Book).Name of person responsible for completing this form:

Distribution: Please send this completed form to your assigned Dominion Energy project designer. If you do not have a project designer assigned to your project, please call 1–866–366–4357 or forward to accountsupport@domenergy.com

Print Signature Date

Total Square Footage Conditioned Space Square Footage Type of Heat

100 amp 200 amp 400 amp 600 amp OtherVoltage (Check one)

1 Phase, 3 Wire, 120/240

3 Phase, 4 Wire Wye, 120/2081 Phase, 3 Wire, 120/208

Other:

Meter Location Desired (Check one)

Indoor (Dominion Energy approval required)Outdoor (Must be installed on front or side of new residences)

Motor Equipment (excluding heating and cooling)

Description Phase 1 or 3

# of Motors

Hrs of Use per Week

HP

Provide a Description of any Renewable Energy Generation, if applicable

Garage (Non business use)Other

Estimated Usage

Hours per week

tons

kW

kW

Cooling (Non Heat Pump A/C)Heat Pump (Unit # 1)Heat Pump (Unit # 2)Heat Pump Strip Heat (Unit # 1) Heat Pump Strip Heat (Unit # 2) Electric Heat (Baseboard or Furnace) Standard Water HeaterTankless Water HeaterDryerInterior LightingExterior LightingReceptaclesCooking EquipmentRefrigeration Equipment ComputersElectric Vehicle Charging

kW

Type of ServiceCheck all that apply to this service request.

Service CharacteristicsLoad Wires – Include conductor size, number of sets, and type of load conductors.Terminations – Indicate where the customer’s conductors and Company conductors will terminate together. If in a switchgear or connection box, please provide the specific number and manufacture of equipment.

Service SizeCheck the size of panel or switchgear.

VoltageCheck the requested voltage to be delivered to the building.

Meter Location DesiredCheck the preferred meter location (subject to Dominion Energy approval).

Renewable EnergyProvide a description of all renewable energy generation systems including generation type (solar, wind, etc.) and anticipated system output capacity.

Electrical Load (excluding motors)Enter all requested load information using tons or kW. It is very important that only connected load is listed. This load letter is for Dominion Energy’s use in sizing electrical facilities. Required capacity (per NEC) should not factor into the load data supplied.

Motor Equipment (excluding heating and cooling)List all motors, their size and weekly hours of operation.

General InformationService Location:

Square Footage:

Conditioned Square Footage:

Customer Contact:

Type of Heat:

Electrical Contractor:

Street Address, City & State of building being served.

Total floor space of building.

Total floor space of building subject to heating and cooling.

Name, Address and Phone Number of a contact representing the ultimate customer.

Electric, gas, propane, oil, other (please specify).

Name, Address and Phone Number of the electrician performing the work for this service.

Form No. 742705 (July 2021) © 2021 Dominion EnergyPage 2 of 2

Use of Premise:Check the use of the new building. An example of a seasonable residence is a river home, mountain home, vacation home, etc. An example of an “other” residential building is a barn, pool house, club house, etc. If the garage will be used for commercial purposes, use the “Nonresidential” load letter.

Estimated UsageEnter the number of hours per week this building will be used.

Instructions